Articles: emergency-services.
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Bull Am Acad Psychiatry Law · Jan 1995
Differential use of admission status in a psychiatric emergency room.
The goal of this study is to understand how different admission statuses of varying degrees of restrictiveness (informal, voluntary, emergency admission, and involuntary admission on medical certification) are used in the psychiatric emergency room. The study included 656 consecutively admitted patients from a psychiatric emergency room over 28 months. Data were analyzed univariately and using two discriminant function models. ⋯ Emergency admission patients (21%, n = 138) were characterized by being between 40 to 50 years old, having a diagnosis of psychoactive substance abuse, having previous outpatient treatment, and having been referred by emergency service. The major difference between involuntary admissions and voluntary was that the former were more often actively psychotic or referred by police or court. The major difference between emergency admission and involuntary admission on medical certification seemed to be that patients with a more available support system, whose primary diagnoses was not substance abuse and who were suicidal, were preferred for involuntary admission on medical certification.
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A survey was conducted of the telephone callers who sought advice from the accident and emergency department of a 250 bed public hospital. The aim of the one month long survey was to determine the extent of the department's telephone triage and whether there was a need for formal protocols that reflected the medical and legal responsibilities attached to giving health-related advice by telephone. ⋯ Callers were advised by the registered nurses or doctors who happened to answer the telephone and there were no guidelines and no documentation of calls. As a result of the study, the Riverina Health Service instituted telephone triage protocols for all hospitals in its area and nurses now receive inservice education about their telephone triage role and responsibilities.
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Changing macroenvironmental factors have caused hospital administrators to reassess their positions across all service lines and market segments. This pilot study explores relationships among the service experience, satisfaction and future patronage decisions among 368 Medicare patients, an often overlooked segment, who were recent users of a hospital emergency room. Results show widespread dissatisfaction with aspects of care. Many of these patients report that they do not intend to return to the same emergency room and would discourage others from choosing it.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cost analysis of stapling versus suturing for skin closure.
A randomized, prospective study was performed to test the null hypothesis that there is no difference between the cost of stapling and suturing for skin closure of selected linear lacerations. Appropriate wounds were randomly assigned to be closed by staples or sutures. ⋯ The average total cost per case was $17.69 (with suture kit) and $7.84 (without suture kit) for the staple Group compared with $21.58 for the suture Group (P = .0001 for each). It is concluded that stapling is less costly than suturing and that the advantage appears to increase as laceration length increases.